That Bill C-9, in Schedule 1, be amended by replacing “amprenavir” and the dosage forms, the strengths and the routes of administration specified in that Schedule in relation to the product with the following:

That Bill C-9, in Schedule 1, be amended by replacing “ceftriaxone” and the dosage forms, the strengths and the routes of administration specified in that Schedule in relation to the product with the following:

That Bill C-9, in Schedule 1, be amended by replacing “delavirdine” and the dosage forms, the strengths and the routes of administration specified in that Schedule in relation to the product with the following:

“delavirdine capsule or tablet, 100 mg (as mesylate)”

Motion No. 16

That Bill C-9, in Schedule 1, be amended by adding the following in alphabetical order:

“isoniazid + pyrazinamide + rifampin tablet, 50 mg + 300 mg + 120 mg”

Motion No. 17

That Bill C-9, in Schedule 1, be amended by replacing “lamivudine (3TC)” and the dosage forms, the strengths and the routes of administration specified in that Schedule in relation to the product with the following:

That Bill C-9, in Schedule 1, be amended by replacing “zalcitabine” and the dosage forms, the strengths and the routes of administration specified in that Schedule in relation to the product with the following:

“zalcitabine capsule or tablet, 0.375 mg or 0.750 mg”

Motion No. 20

That Bill C-9, in Schedule 2, be amended by adding the following, in alphabetical order:

It is my duty pursuant to Standing Order 38 to inform the House that the question to be raised tonight at the time of adjournment is as follows: the hon. member for Renfrew—Nipissing—Pembroke, Agriculture.

Madam Speaker, I sometimes stumble through some of the medicine names which can be tongue twisters and very difficult to pronounce.

I am pleased to have a second opportunity to speak to the bill, in particular to the motions in Group No. 2 that we are referencing here, a specific series of drugs that have been introduced.

I want to first and foremost commend the committee work, as we have heard from several members. The fact that it is coming forward this way is because the committee agreed at that time to review things and make sure that Health Canada could review some of my amendments which could then be introduced at report stage. That is to the credit of the committee, the flexibility that evolved out of that, to ensure that we were doing the right thing.

Hopefully this group of amendments will provide additional resources to assist people around the world who are suffering with different types of conditions. The premise of the bill is to ensure that a distribution of generic drugs at a lower cost can get out to people who really need them. This is why we are doing this at this particular time.

These amendments are representative of a series of amendments that I proposed at the clause by clause stage. These are drugs to which Health Canada raised no objection. I thank those officials for their advice and assistance in my preparation of the list of motions on drug products. They were very professional and courteous, and made sure they were open for questions, especially given the tight timeframes under which we were working. They were very good in terms of getting back to me and my staff. It is important to recognize the work of the Health Canada officials.

Those officials have also circulated a copy of their recommendations to me, which I hope has been of use. Because of the way schedule 1 is worded, members will note that for some of the amendments, like that of amprenavir, it is simply the addition of a capsule formula but the amendment had to read to replace the whole line. It was a procedural issue but I hope the clarification is useful and once again provides for no other obstructions in getting those types of medicines to people who really need them.

This series of drugs presented here are indicated for a variety of different illnesses that affect the developing world, quite tragically. There are solutions and that is what some of these drugs can do, providing the right infrastructures for not only the countries themselves but also the humanitarian groups that are assisting them.

The amendment for amprenavir, Motion No. 12; delavirdine, Motion No. 15; lamivudine, Motion No. 17; and zalcitabine, Motion No. 19, are simple technical additions to include either the capsule or tablet formulation that is not currently in Bill C-9. All of these drugs are indicated for use in the treatment of HIV. We know from a number of speakers how many individuals across the developing worlds are suffering from HIV, and these drugs will provide some additional opportunities for them.

The amendment on ceftriaxone, Motion No. 13, simply adds the 500 milligram dosage to what already exists in schedule 1. It provides another opportunity for a specific case, if it is deemed necessary, for those wishing to assist.

The first of the new drug products which I propose to include is clarithromycin, Motion No.. 14. It is used to treat an AIDS-related infection called mycobacterium avium complex and also has other more general anti-infection uses.

As members of the House may be aware, the World Health Organization, in its attempts to facilitate quality, effective and safe HIV-AIDS, tuberculosis and malaria drugs, regularly updates what are referred to as “pre-qualified” drugs. Essentially it means that international experts appointed by the World Health Organization examine products submitted by companies around the world and assess whether they meet World Health Organization standards of quality, safety and efficacy.

Clarithromycin is on the WHO's pre-qualified list of HIV-AIDS drugs. Therefore it is one that has been vetted through the international process and we feel that that is a good reason to support it. It also apparently is a very expensive drug and, therefore, including it in the bill, which has the ultimate aim of providing access to medicines through cheaper generic versions, especially for the treatment of HIV-AIDS, tuberculosis and malaria, would make the bill even more able to achieve its aims. That is a benefit and a credit to the bill.

The second new drug that I have proposed is the fixed dose combination drug of isoniazid, pyrazinamide and rifampin, Motion No. 16. This combination of the three drugs is an anti-tuberculosis agent that is used for short course treatments of pulmonary tuberculosis in the initial phase.

According to Stop TB, tuberculosis infects one in three people worldwide. Between two million and three million die each year of this curable disease. This combination drug, also known as rifater, is also an expensive drug and could be very advantageous and important in the treatment of tuberculosis, which would, like clarithromycin, meet the aims of the bill.

The third of the new drug products I propose to introduce is moxifloxacin hydrochloride, Motion No. 18. Moxifloxacin is officially indicated for the treatment of what is called community acquired pneumonia, which simply means pneumonia acquired through regular contact as opposed to the complications from HIV-AIDS or a disease like that.

According to the Centre for Disease Control in Atlanta, approximately 5% to 10% of all children under five years old in developing countries develop pneumonia each year and acute respiratory infections like pneumonia cause approximately two million deaths among children under five each year and are the leading cause of death in that age group. In addition to children, approximately 100 of every 100,000 adults are affected yearly and the elderly are at particular risk according to WHO information. I feel the moxifloxacin should be included because of its potential to help treat people affected with pneumonia.

I believe that all these drugs are useful to have available as options to countries wishing to participate. My intent here, of course, is not to indicate that they should be used by anybody but I believe they should be available as options. However those people will decide.

As I mentioned and as the committee heard, there is consensus that the presence of a schedule at all provides further inflexibility in ensuring that countries have access to the drugs that they need. A list by its nature is exclusionary because it does not include all possibilities. If a country wants a drug that is already approved for use and sale here in Canada on the patent register, et cetera, it will still have to start a process for the drug to be included before a generic producer could apply for a voluntary or compulsory licence to supply the country with that drug. It is a bit of a barrier and it is one of the concerns we have with the bill.

I will quote from the testimony of our committee hearings by the representative of Médecins sans frontières about schedule 1:

So our proposal for that is simply to remove the schedule. Neither TRIPS nor the Doha declaration saw any list of medicines, and in fact developing countries fought very hard that there was no such list. It was a big point of discussion during those negotiations.

That is why we believe the list is something that the bill would be better without.

The government representatives have repeatedly testified that the presence of the schedule is intended as a guide and that it is meant to be flexible. I hope the members will consider supporting these amendments, particularly those that would introduce new eligible drugs important for the treatment of HIV-AIDS, tuberculosis and pneumonia to show that schedule 1 of this bill will be flexible as the government has claimed it will be. I am sure that they will be because there has been a lot of goodwill about the bill.

I commend all the parties that were a part of it. In fact, people across Canada are probably wondering why for the first time in a long time members are not shouting back and forth at different points but the fact is that we actually are talking about something that is very beneficial. We may still have differences of opinion about the bill but there is a great consensus for moving it forward rather quickly and also improving it where there are items of consensus. I think that is important to recognize.

These groups of amendments are intended to improve the bill and I hope they will receive the support they merit because they are important for many people throughout the world.

Joe FontanaLiberalParliamentary Secretary to the Prime Minister (Science and Small Business)

Mr. Speaker, with regard to Group No. 2, the amendments put forward by the member for Windsor West, I want to repeat that the committee members worked really well together and the spirit of the House of Commons and the members working together has not diminished anything at all.

I want to talk a little about the importance of the schedule in this bill. The schedule deals with the list of medicines that we are recommending. This is a list of pre-approved products that can treat HIV-AIDS, tuberculosis, malaria and other epidemics. This list will be inspired by the World Health Organization's list of essential medicines. The WHO list provides a sound guide to the most efficacious, safe and cost effective medicines for priority conditions in a basic health care system.

The decision to include such a list represents a compromise solution between those who wanted a narrow list of eligible medicines and those who wanted no list at all.

Some have suggested that this list is meant to exclude certain products. This is not the case. It is a tool to expedite the process of acquiring a compulsory licence for those products that have been found to be safe, effective and of high quality. The list is not set in stone.

The government recognizes the need for some flexibility in order to meet future demands of importing countries. For this reason, there are provisions in the bill to allow for the adding of products as necessary.

I think the member for Windsor West alluded to the fact that during the committee's clause by clause study of the bill a number of amendments put forward by himself and the government were to add to that list of medicines. We thank the hon. member for doing that and bringing those medicines to our attention.

However I want to also stress that medicines obviously will be approved in Canada over the next number of months and years. I want to tell the House of Commons that the bill contains a provision that an advisory committee will be created that will be composed primarily of experts and medical health practitioners who will make the recommendations to the government in this regard. I should note that the government is all ready, as I proposed amendments to schedule 1.

This is only the start of the process and it is a great start in terms of telling the world that Canada is prepared to embark on providing cheap medicines to those most in need and ensuring that those medicines get to the people. We have added products and the member has suggested one.

I might mention to the member and to the House that we as a government are prepared to support Motions Nos. 12, 13, 15, 16, 17, 19 and 20. I would like to say to the member that, unfortunately, at this point in time we cannot support Motion No. 14.

I only want to bring this to his attention, even though I gave him the assurance earlier this afternoon, that the fact that we are talking about this, the reference will be made immediately to Health Canada to look at these amendments a lot closer to ensure that these will be safe and will essentially do what the hon. member wants them to do.

For those who might be interested, let me explain why we cannot support Motions Nos. 14 and 18. Motion No. 14 deals with one therapy within a broad spectrum of antibiotic use to treat secondary bacterial infections. It is not necessary for the treatment of HIV, tuberculosis or malaria. This drug also does not figure on the WHO list of essential medicines and, therefore, it is not clear why this would be a preferred drug in this particular class.

As I said, the government cannot support that motion at this point in time but commits to referring the drug to the advisory committee at the earliest possible opportunity for its recommendation. I think I have already indicated the importance of that particular advisory committee.

With regard to Motion No. 18, it is also a broad spectrum antibiotic used to treat secondary bacterial infections. It is not necessary for the treatment of HIV, TB or malaria. This again does not figure into the list of essential medicines of the WHO.

We want to be clear. I think I indicated before that it is important for us to be very, very careful when we suggest that certain medicines be available, and be available for the purposes for which they are intended. As I indicated, while we can support all those other amendments, we cannot support Nos. 14 and 18. We will refer them to the advisory committee as quickly as possible so they can be added to the list once some due diligence has been done.

I again want to applaud and thank the member for Windsor West for providing us with the additional list of medicines, which we are happy to support and add to the schedule this evening.

Mr. Speaker, once again I have the opportunity to congratulate all the members of the Standing Committee on Industry, Science and Technology. It was a great experience to see all the members of this committee working together in the interest of poor and developing countries. It was a sight to see and I would like to congratulate everyone.

Regarding the motions in Group No. 2, I was there when the member for Windsor West tabled a series of amendments to the bill in order to include other drugs on the list or in the government's program with respect to this bill, or to add other forms of drugs. For instance, a drug may have already been on the list, but only in tablet form and not as a soluble or other type. I supported almost all the motions.

The motions tabled mainly by the member for Windsor West regarding the drugs that should be included in the program and that I did not support, were Motions Nos. 14 and 15. Motion No. 14 is to add clarithromycin and Motion No. 18 is to add moxifloxacin hydrochloride.

To me, the principle is quite simple: not to authorize the use or the export of drugs in developing countries for treatment that we would not use here, if it is not authorized in Canada.

The two drugs listed in Motions Nos. 14 and 18, which the member for Windsor West wants on the list so they can be used for this kind of illness or that kind of illness, are not authorized here in Canada. Is the idea that we are going to experiment? Are we going to use people of the developing world and the least developed countries as guinea pigs for treatments that we have not as yet authorized here?

No. I think the government's position is clear. The drugs have to be authorized by our experts here in Canada for a specific use. Then the licences, if licences are to be given out, would be based on Health Canada, not on nothing, because that is basically what it would be.

I seriously think we are finding a certain attitude here. Let me go back to Motion No. 2, which would actually overturn a subamendment adopted after full and fulsome debate in committee. An overwhelming majority of the members voted in favour of the subamendment, yet the member for Windsor West wishes to overturn that democratic decision taken in committee in order to allow persons or entities to contract for these cheaper drugs here in Canada and go into countries without having any link whatsoever with the government in place.

The subamendment that the committee in its wisdom adopted was based on the fact that we cannot do that and we should not do that. We are not living in a colonialist world. We are no longer living in a Eurocentric world. We are living in a world where we recognize sovereign state to sovereign state, government to government. That is what WTO is all about.

When we come to the list of medications that should be on the schedule, I say let the expert advisory committee determine whether or not they are drugs that could be used for treatments here in Canada. If the advisory committee, in its wisdom and with its expertise, says yes, then the drug would be added to the schedule. We do not add medication to the schedule which has not been approved for that kind of use or has not been approved in Canada for the specific use that the member or organizations intend to use it for in other countries. We do not use people as guinea pigs.

Mr. Speaker, on behalf of the Conservative Party, I want to add a few words to this discussion on the second group of motions to Bill C-9, which deal mainly with adding medicines.

In particular, I want to address the issue of why we will not be supporting the motions put forward by my hon. friend from the NDP. I will reiterate what the government member said. The member for Windsor West did an excellent job at committee, a real tribute to his constituents.

However, there is something we should keep in mind. Many people before us at committee expressed concern about adding medicines. Let us look at the bill. Proposed section 21.03 of the bill reads:

The Governor in Council may, by order,

(a) on the recommendation of the Minister [of Industry] and the Minister of Health, amend Schedule 1

(i) by adding the name of any patented product that may be used to address public health problems afflicting many developing and least-developed countries, especially those resulting from HIV/AIDS, tuberculosis, malaria and other epidemics and, if the Governor in Council considers it appropriate to do so, by adding one or more of the following in respect of the patented product, namely, a dosage form, a strength and a route of administration--

This section really addresses the concern about whether we can add medicines. Perhaps in the future these two medicines may be added, but we do not know at this time. Our party feels that the people who make these decisions should make them within the parameters of this act itself, looking at the massive public health problems afflicting certain nations specifically with regard to HIV-AIDS, TB and malaria. We have to look at it within that umbrella and I really do think that we need to rely on our Department of Health here in Canada to guide us in these matters; that is certainly why we are making the decision we are. Obviously we are open to amending the schedule and adding other medications if that is the desire in the future.

In terms of the advisory council, our party made the motion to ensure that there is parliamentary input into the formation of this council, so that is a welcome addition as well.

I just wanted to add those few explanatory words for my hon. friend. This is why we in the Conservative Party will not be supporting Motions Nos. 14 and 18. We will support the addition to the list of all the other medicines that the government and the Department of Health have okayed and recommended.

Larry BagnellLiberalParliamentary Secretary to the Minister of Indian Affairs and Northern Development

Mr. Speaker, carrying on from where I left off, let me say that my constituents are very happy with the second block of amendments in the sense that this expands the list of eligible drugs. This is what was wanted by a coalition group in my community. Those constituents will be very pleased.

The bill contains schedule 1, the schedule of drugs, which for us is an important part of the legislation. The list reflects a number of drugs that the World Health Organization considers to be essential and which Health Canada is comfortable with in terms of safety, efficacy and high quality.

Although this original list is focused on HIV-AIDS, tuberculosis and malaria, which are very significant pandemics, Health Canada expects that in the future other valuable drugs will be added. There will be a process for that. We will be constituting an advisory committee with members from industry, academia, government, NGOs and the public health field. These are the experts who will help make schedule 1 the best schedule we can maintain to help other countries.

Again, the original schedule is what we are starting out with. It lists the known therapies that we are comfortable with, because we want to send Canadian drugs that we are confident will provide the desired treatments and outcome.

We must remember that the drugs being provided under this humanitarian measure will carry with them the reputation of Canada for safe, effective, high quality medicines. This is why Health Canada will undertake a review of each generic drug that is sent out under licence. Industry Canada and Health Canada will be working together, as they have throughout this bill, to put together the best advisory committee they can. So if any stakeholders are worried that they will be prevented from having a particular drug listed, they do not need to be worried. We will have very capable experts ensuring the desired drugs.

As well, I note that to ensure we really have the very best scientists and other people involved, a measure has been included in the bill to assess all candidates for appointment to the advisory committee and to make recommendations on their eligibility and qualifications.

Not only are there individual drugs to be considered for this humanitarian effort, but we recognize the very important contribution that fixed-dose combination drugs will make in stemming these epidemics.

Fixed-dose combination drugs are becoming central in meeting the WHO's 3 by 5 initiative to see three million people receive effective therapy for HIV-AIDS by the year 2005. These are drugs where there is more than one medicine put together into a single drug so that it simplifies the ability to ensure effective delivery to patients. We are pleased that a number of these sorts of drugs are on schedule 1. Many additional combinations will be identified in the future. The mechanisms we have in place in the bill will allow for their timely consideration.

There are two drugs that we would not like added to the list. The first one, related to Motion No. 18, is moxifloxacin hydrochloride tablet, 400 mg, and intravenous solution, 400 mg/250 ml. This is one therapy among many within a broad spectrum of antibiotics. It is not used to treat HIV, TB or malaria, which we were talking about earlier. The drug does not figure on the WHO list of essential medicines. It is not clear why this would be the preferred drug in its class. Therefore, the government does not support this motion, but commits to referring the drug to the advisory committee at the earliest possible opportunity for its recommendation. With the expertise on that committee, which I have talked about, I am sure it will give us wise counsel.

The other drug we have an issue with is clarithromycin in tablet, 500 mg, tablet extended release, 500 mg, and powder for oral solution, 125 mg or 250 mg. This is one broad spectrum antibiotic among many. It is not used to treat HIV, TB or malaria. The drug also does not figure on the WHO list of essential medicines and therefore it is not clear why this would be a preferred drug in its class. Therefore, the government does not support the motion, but commits to referring the drug to the advisory committee at the earliest possible opportunity for its recommendation.

The WHO pre-qualified medicine list does not indicate that these medicines in Motion No. 14 are essential, only that the WHO has looked at the source of the medicine and found it to meet minimum standards. It is up to other regulators to determine its appropriate use.

Once we establish our advisory council under the terms that I have mentioned, it will have a very effective way of adding drugs to this list as new diseases become apparent and new drugs and drug combinations are put together that would be helpful.

This adds to making this an excellent bill for Canada to lead the way and become the first nation in the world to pass legislation that will help those nations most in need while they are in situations where they cannot afford the drugs. Of course, as their societies and economies progress then they too will be contributors. They will be producing these drugs and they too will be contributors to those less fortunate, and producing the drugs so that everyone in the world will have as much access as possible at as reasonable a price as possible.

The House resumed from April 27 consideration of the motion that Bill C-12, an act to amend the Criminal Code (protection of children and other vulnerable persons) and the Canada Evidence Act, be read the third time and passed, and of the amendment.

Mr. Speaker, I am pleased to take part in today's debate on Bill C-12, an act to amend the Criminal Code, the protection of children and other vulnerable persons, and to make changes to the Canada Evidence Act.

I will speak to a part of the bill that has not received a great deal of attention thus far but contains important provisions for children and other vulnerable witnesses.

Bill C-12 contains a range of reforms to the Criminal Code that would make it easier for a child or other vulnerable persons who are witnesses to provide their testimony at criminal trials. These provisions build on the current Criminal Code provisions that recognize that participating in the justice system as a victim or witness is not a pleasant experience. It is usually a very traumatic experience, particularly for children.

The proposed changes in Bill C-12 recognize that despite the progress that we have made in developing a justice system that is responsive and sensitive to the needs of children and all victims and witnesses, more still needs to be done.

Our law currently permits the judge to exclude members of the public from the courtroom in some circumstances. For example, this could be ordered where a child victim of sexual abuse is giving his or her evidence.

In addition, a publication ban may be imposed to protect the identity of young victims. A support person may accompany a young victim and some young victims may give their evidence from behind a screen or on closed-circuit TV. The law also protects a young victim or witnesses of a sexual or violent offence from having to face questioning from an accused who represents him or herself.

Videotaped interviews are also permitted to be used as evidence where the child adopts the videotape at the court proceeding.

The current provisions when they are used work well. However, due in part to the fact that some of these provisions have been amended over time rather than as one comprehensive package, we now have a different series of tests for the use of various testimonial aids, different offences to which they apply and different age categories of young persons who can benefit.

Obviously the bill goes a long way toward resolving some of these concerns and hopefully I will have a chance to explain it at another sitting of the House.

The House resumed consideration of Bill C-9, An Act to amend the Patent Act and the Food and Drugs Act (The Jean Chrétien Pledge to Africa), as reported with amendment from the committee, and of Motions Nos. 2, 14 and 18.

Mr. Speaker, if you were to seek it, I think you would find unanimous consent for members who voted on the previous motion to be recorded as having voted on Motions Nos. 14 and 18 now before the House, with Liberal members being recorded as voting nay, with the exception of those Liberals wishing to be recorded as voting otherwise.